What information should be included in informed consent for chest tube (chest drainage tube) insertion?

Informed Consent for Chest Tube Insertion

The doctor performing the chest tube insertion, or an appropriately trained individual with sufficient knowledge of the procedure, must obtain informed consent that includes explanation of the procedure's nature, significant foreseeable risks and their consequences, benefits, and alternatives including no treatment. 1

Core Components That Must Be Discussed

Nature and Purpose of the Procedure

• Explain what chest tube insertion entails: placement of a flexible plastic tube through the chest wall into the pleural space to drain accumulated air (pneumothorax) or fluid (pleural effusion, blood, pus) 2, 3
• Clarify why the procedure is being recommended for this specific patient's condition 1
• Describe the technique that will be used: small-bore (≤14F) versus large-bore drain, Seldinger technique versus blunt dissection, and whether imaging guidance (ultrasound or CT) will be employed 2, 4

Significant Risks and Complications

The consent discussion must cover both common and serious complications, tailored to what this particular patient would consider relevant 1:

Common complications:

• Pain during and after the procedure 2
• Drain blockage 2
• Accidental dislodgment 2
• Infection at insertion site 2

Serious complications (though rare, must be disclosed):

• Organ injury (lung, liver, spleen, diaphragm) 2, 4
• Hemothorax from vascular injury 2, 4
• Lung laceration 4
• Re-expansion pulmonary edema 2
• Pleural empyema 2

Anesthesia Options and Associated Risks

• Discuss whether local anesthesia, sedation, or general anesthesia will be used and the rationale for the choice 1
• For sedation: explain that it should only be administered by personnel trained in conscious sedation, airway management, and resuscitation with full monitoring 1
• Anesthesia-specific risks including nausea/vomiting, sore throat (if intubated), and numbness at injection sites 1

Alternatives to the Procedure

• Alternative drainage methods: needle aspiration/thoracentesis for fluid collections 1
• Conservative management (observation) if clinically appropriate 5
• Risks and benefits of choosing no treatment must be explicitly stated 1, 5

Process Requirements

Who Should Obtain Consent

The physician performing the procedure must obtain consent, or delegate to an appropriately trained individual who has sufficient knowledge to explain the procedure's nature and risks. 1 This ensures the person obtaining consent can answer questions accurately and address patient-specific concerns 1.

Timing and Environment

• Consent must occur in a non-pressured environment with adequate time for explanation and discussion 1
• Avoid obtaining consent immediately before the procedure when possible, as this limits the patient's ability to process information and ask questions 1, 6
• Patients must have the capacity to process the information provided and the freedom to ask questions 1, 5

Communication Considerations

• If the patient does not speak English, use a professional interpreter—never rely on family members or friends to translate 1 This ensures accuracy and reduces coercive influence 1
• Provide written information in the patient's language when available, though written consent alone is insufficient—oral explanation is essential 1, 6
• Tailor the discussion to what this particular patient wants to know, not a rigid checklist 1

Patient-Specific Risk Assessment

Identify and discuss factors that increase procedural risk for this individual patient: 1

• Coagulopathy or platelet defects (correct before insertion when possible) 1
• Anticoagulant therapy 7
• Recent cardiac or thoracic surgery 1
• Immunocompromised state 7

Documentation Requirements

Document the informed consent discussion clearly, including: 1, 8

• Specific risks, benefits, and alternatives explained 1, 8
• Patient questions and responses provided 8
• Any patient-specific concerns or risk factors discussed 1, 8
• The patient's agreement to proceed 9, 8

Critical Pitfalls to Avoid

• Never minimize pain or discomfort expectations, as this leads to feelings of mistrust and betrayal 1
• Do not withhold information because you fear it might make the patient anxious or deter them from a beneficial procedure—information may only be withheld if disclosure would pose a serious threat to the patient's health 1
• If a trainee will insert the drain, specific consent may be required if there are additional risks from inexperience, and the patient has the right to know who is performing the procedure and their qualifications 1, 8
• Patients may withdraw consent at any time without penalty 1